Avian Flu Presentation - Homepage | Ohio Manufacturers' …€¦ · · 2013-06-18Situation...
Transcript of Avian Flu Presentation - Homepage | Ohio Manufacturers' …€¦ · · 2013-06-18Situation...
Agenda
8:00- 8:30 a.m. Registration
8:30- 8:40 a.m. Welcome/Introductions – Bob Klonk
8:40- 9:00 a.m. Overview of Pandemic Flu – Bob Salata, M.D.
9:00- 9:15 a.m. Risk Managers Prospective – Eric Smolenski / Dr. Bill Gegas, M.D.
9:15- 9:30 a.m. Legal Perspective – Chris Johnson
9:30- 9:45 a.m. Community Preparedness – Terry Allan
9:45-10:00 a.m. Carrier Perspective – Richard Thomas
10:00-10:30 a.m. Q&A
Worldwide Occurrences of Bird Flu
Recent Studies show the following countries’ human populations have been infected with the H5N1 virus
BakuBorneoChinaEgyptEthiopia
IranMyanmarThailandTurkeyVietnam
Source: www.bserv.com/users/lesliq.htm
Pandemic Influenza: Global Epidemiology, Clinical
Manifestations and Management
Robert A. Salata, M.D.Professor and Vice-ChairDepartment of Medicine
Chief, Division of Infectious DiseasesCase Western Reserve University
University Hospitals Case Medical Center
Robert A. Salata, M.D.
Robert Salata is Professor of Medicine, International Health, Biostatistics & Epidemiology at the Case Western Reserve University School of Medicine. He is Chief of the Division of Infectious Diseases and serves as Medical Director for Infection Control & Prevention at University Hospitals of Cleveland where he also serves as Medical Director of the Travelers’ Health Care Center.
Dr. Salata received his M.D. degree from Case Western Reserve University and served his residency in Internal Medicine at University Hospitals of Cleveland. He was a fellow in Infectious Diseases and Geographic Medicine at the University of Virginia School of Medicine.
Dr. Salata is a recognized clinical and research expert in the epidemiology, diagnosis and treatment of infections in immunocompromised hosts (especially HIV-infected), sexually transmitted diseases, nosocomial pneumonia and infections, and transplant-associated infections.
Objectives
To review the global epidemiology of avian influenzaTo discuss the past pandemics and the implications for pandemic avian influenzaTo detail the common clinical features of avian influenzaTo discuss strategies to management of avian influenza
The Burden of Influenza
Seasonal InfluenzaGlobally: 250,000 to 500,000 deaths each year
In the United States each year:– 36,000 deaths– >200,000 hospitalizations – $37.5 billion in economic costs from influenza and
pneumonia
Pandemic InfluenzaAn ever-present threat
Excess P&I Hospitalization Ratesby Risk Status
Barker & Mullooly (1980, 1982)
0
100
200
300
400
500
600
700
800
0 - 4 5-14 15-44 45-64 65+
Age (Years)
Exc
ess
P&
I Hos
pita
lizat
ions
P
er 1
00,0
00 P
erso
ns
Low Risk High Risk
Pandemics Do Happen!
H1
H1H3
H2
H7*
H5*
H9*
1918SpanishInfluenza
H1N1
1957Asian
InfluenzaH2N2
1968Hong KongInfluenza
H3N2
1980
1997
1915
*Avian Flu
2003 2004
1977
1996 2002
1925 1935 1945 1955 1965 1975 1985 1995 2005
2003-2006
1998 1999
2003
Rapid global spread (morbidity and mortality)Shortages and delays – vaccines and antiviral medicationsIncreases burden on hospitals and outpatient care systemsDisrupts national and community infrastructures
Concerns about Pandemic Influenza
Cumulative Number of Confirmed HumanCases of Avian Influenza A/(H5N1) Reported to
WHO, September 27, 2006
251 total cases, 147 deaths (59%)
Spanish flu was a bird flu – http://www.hhs.gov/nvpo/pandemics/annotatedSlide.ppt
1918 “Flu hospital” in US
Effects of Past Pandemics on the US
Source: NVPO.
Infants; elderlyH3N234,0001968-1969
Infants; elderlyH2N270,0001957-1958
Young; healthy adultsH1N1500,0001918-1919
Populations at Greatest Risk
Influenza A Subtype
Estimated US Deaths
Pandemic Years
Planning Assumptions: Health Care
Severe (1918-like)Moderate (1957-like)
1,903,000209,000Deaths
745,50064,875Mechanical ventilation
1,485,000128,750ICU care
9,900,000865,000Hospitalization
45 million (50%)45 million (50%)Outpatient medical care
90 million (30%)90 million (30%)Illness
50% or more of those who become ill will seek medical careNumber of hospitalizations and deaths will depend on the virulence of the pandemic virus
Direct Avian –Human Infection
Humanvirus
Avian Reservoir
Pandemic Strain Emergence:Direct Infection
Avian virus
Avian Reservoir
Avian virus
Humanvirus
Pandemic Strain Emergence:Reassortment of Influenza A Viruses
other mammals? New reassorted
virus
Clinical Manifestations of Avian Influenza
The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches)Other features of avian influenza can include eye infections (conjunctivitis) and diarrhea not commonly encountered with seasonal fluThere is frequently the rapid development of pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications
H5N1 Influenza Severe Pneumonia –Vietnam 2004
Hien TT et al. New England J Med. 2004;350:1179-1188.
DAY 5 DAY 7 DAY 10
Diagnosis of Human Avian Influenza
Recognition of the global epidemiologyHigh level of clinical suspicion (but symptoms are not specific)Respiratory secretions need to be collected carefullyCulture or PCR (genetic) methods to confirm the virus
Antiviral Agents For Influenza
PO/IV/IMPeramivir (BCX-1812)*POTamifluOseltamivir (GS4104)
InhaledRelenzaZanamivir (GG167)NA inhibitors
POFlumadineRimantadinePOSymmetrelAmantadine
M2 inhibitors
RouteBrand nameClass/agent
*Investigational at present in USA.
Oseltamivir Therapy in H5N1:Thailand and Vietnam, 2004-5
3 (25%)12No
6 (24%)25Yes
No. (%) SurvivorsNo. PatientsOseltamivir
Treatment
NEJM. 2005;353:1374.
Options for Pandemic Vaccines
Inactivated vaccine resembling currently licensed inactivated vaccine
Live vaccine resembling currently licensed live vaccine
Inactivated vaccines with experimental adjuvants/route of administration
Experimental approaches
Response Rates Following One or Two Doses of rHA H5 Vaccine
0
20
40
60
80
100
Placebo 25 mcg 45 mcg 90/10 mcg 90 mcg
Dose 1Dose 2
Per
cent
resp
ondi
ng*
*4-fold or greater increase to a titter of 1:80 with positive WB.Treanor. Vaccine. 2001;19:1732.
Situation Report: Avian Influenza
Widespread and spreading prevalence in migratory birds; broad host range
Continued outbreaks among domestic poultry
Mammalian infection (cats, pigs, etc.) lethal
Virus is evolving
Sporadic human cases (>140 reports to date)– Most in young and healthy– Case-fatality 50%– Rare person-to-person transmission
Sustained and rapid person-to-person transmission
WHO Phases and US Stagesof a Pandemic
New domestic animal outbreak in at-risk country0
Spread throughout US5
First human case in North America4
Widespread human outbreaks in multiple locations overseas
3
6Efficient and sustained human-
human transmissionPandemic Period
US StagesWHO Phases
5
4
3
2
1
6
2
1
Recovery and preparation for subsequent waves
Confirmed human outbreak overseas
Suspected human outbreak overseas
No or very limited human-human transmission
Pandemic Alert
(New virus causes human cases)
Evidence of significant human-human transmission
Evidence of increased human-human transmission
Higher risk of human cases
Low risk of human casesInter-Pandemic Period
(New virus in animals, no human cases)
Our Health Protection Preparedness System:A NETWORK of Shared Responsibility
Local - State - Federal
Domestic – internationalPublic – privateMulti-sectorNon-partisanAnimal – humanHealth protection –homeland security –economic protection
HealthcareDeliverySystem
Federal Partners
Educational Institutions
Business & Workers
Local /State /Federal Public
HealthSystem
Planning Assumptions in the US (ll)
The typical incubation period for influenza averages 2 days.Persons who become ill may transmit infection for one-half to one day before the onset of illness. On average about 2 secondary infections will occur as a result of transmission from someone who is ill.In an affected community, a pandemic outbreak will last about 6 to 8 weeks.Work/school absenteeism may be as high as 40% at the peak.At least two pandemic disease waves are likely.
Pandemic Influenza Preparedness
Preparing for a pandemic now will mean:
Lives saved during seasonal influenza– Modern seasonal influenza vaccine for all who need it
– New antiviral drugs for prevention and treatment
Community health protection from other threats
Peace of mind
Preparedness
Summary
A pandemic will place incredible demands on the healthcare systemPandemic preparedness actions must begin now– Be familiar with national, state, and local plans
Early detection of initial cases/clusters is essential– Know reporting guidelines
Monitoring the impact of the pandemic will be critical– Assist federal, state, and local officials
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An Employer’s Perspective
Eric SmolenskiVice President of Human Resources
Worthington Industries
Bill G. Gegas, M.D.Medical Director
Worthington Industries
Eric M. Smolenski
Eric Smolenski is a graduate of The Ohio State University, with a bachelor's degree in accounting. He received his MBA in 2004 from Otterbein College in Columbus, Ohio.
Mr. Smolenski has served in numerous capacities throughout his career at Worthington Industries including accounting, treasury, finance and human resources. Mr. Smolenski was named vice president of human resources of Worthington Industries in December of 2005.
Introduction
Eric Smolenski – VP Human ResourcesDr. Bill Gegas – Director, Medical Center
8,000 Employees Worldwide10 Countries62 Facilities– mostly production facilities
Worthington Industries Preparedness
Utilizing CDC Business Planning ChecklistEstablishing Avian Flu TeamDetermining communications/education plan Review sick time, leave and travel policies and establish guidelines to be implemented during a pandemicReview existing business continuity plansCapitalizing on WII Medical Center Facility
Establishing Avian Flu Team
Purpose– Raise awareness of potential pandemic and consequences – Coordinate resources to mitigate possible impact
Develop policies and internal proceduresDevelop reporting and communication processes
Team Representation– Human Resources / Benefits / Medical Center– Communications / IT– Risk Management– Business Units
Determining Communicationand Education Plan
Assess key communications personnelInitial delivery of information & education – Communication employee/family preparedness plan
Dept of Health and Human Services Guide (HHS)– Raise awareness of Company’s approach
On-going communication – Monitoring of WHO / CDC releases– Adapt plan based upon updated information– Revision of policy will depend on geographic area and alert
levelReview distribution channels (electronic, intranet, phone calls, virtual meetings, bulletin boards, etc.)
Reviewing Current Business Continuity Programs
Review redundant business capabilities– Steel Processing, Blanking, Roll-forming, Valves
Update plans and communicate as necessaryIdentify critical employees and ensure remote access is established– Contact Information
Reviewing Sick, Leave and Travel Policies and Establishing Guidelines
Currently have a liberal sick leave policyAssessing mandatory leave policy – Leave work / don’t come in if experiencing flu symptoms
Restrict travel to affected geographic areasGuidelines for returning from an affected area– “Shelter in”
Reduction in centralized meetings/trainingAssessing policy for mask usage and distribution